Hospice: A better way for terminal care
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| Dr. Clyde Smith, center, is surrounded by clinic staff in a picture for the cookbook cover. |
Dr. Clyde Smith gently suggests an alternative – Hospice.
“The medico-mechanical way of taking care of people with terminal illnesses that we have used over the last 40 years is not a good approach as people end their lives,” says Dr. Smith, a board-certified hematologist/ hospice/ palliative care physician at Medical Specialty Clinic. “Hospice is a better way of taking care of people at the end of their life.”
Rather than maintaining an aggressive approach to fighting a losing battle with an illness, Hospice focuses on symptom management, a patient’s comfort and helping patients and their families through a difficult time, Dr. Smith says. “It works because it is a team approach, involving a physician, nurse, aide, social worker and chaplain working together.”
Hospice treatment is an organized approach to taking care of patients with any terminal illness. In the United States, Hospice is an outpatient program with patients getting care at home or in a Hospice House.
As a hematologist/oncologist, Dr. Smith treats life-threatening diseases of the blood and cancer. He was one of the first medical subspecialists in Jackson when he started the Medical Specialty Clinic in 1979.
Hospice of West Tennessee started as a grassroots movement in 1983. In 1987, West Tennessee Healthcare took over the program. Dr. Smith was asked to be medical director of Hospice in 1989.
Within a year of working with the program, he says, he had a greater insight of what happens to patients with a terminal illness and their families. “I saw what help Hospice gave them. It addresses not only the physical aspects, but also the psycho-social and spiritual aspects of a terminal illness.”
When caught early enough, most cancers today are curable, Dr. Smith says. With some patients, though, the cancer can’t be cured. He reaches a point in the patient’s treatment, he says, when medicine has done about all medicine can do to treat the cancer, when trying another drug or another treatment method may prolong life a little, but would likely create side effects that would outweigh the benefits.
That’s when Dr. Smith brings up Hospice, of “focusing on what we can do to improve the quality of your life.”
Some patients and their families ask about Hospice before he suggests it. Others have misconceptions. They inaccurately think that Hospice means the physician has given up on them, or that they can no longer go to the hospital, or that they will be doped up with medicine, Dr. Smith says.
Medicare and many other insurance policies will cover Hospice care. To receive Hospice, two physicians have to certify that if the disease runs its usual medical course, most patients with it will live six months or less. “Medicare understands that no one can predict death,” Dr. Smith says, and will continue to provide coverage if a patient lives longer than six months. He’s even taken some people out of the Hospice program because they did get better.
Dr. Smith is looking forward to another oncologist joining him in practice at Medical Specialty in the next few years. The extra help will afford him the time to concentrate on Hospice and palliative medicine, which overlaps Hospice care and also focuses on comfort and symptom management.
Dr. Smith and others would like to develop a palliative care unit of six to eight beds at Jackson-Madison County General Hospital and to open a Hospice House for those Hospice patients who don’t have the support they need at home. “Hospice is special to me,” Dr. Smith says. “It’s an important part of what I do.”